Moradi Najmeh, Rashidian Arash, Nosratnejad Shirin, Olyaeemanesh Alireza, Zanganeh Marzieh, Zarei Leila
1Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran.
2School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
Cost Eff Resour Alloc. 2019 Feb 28;17:4. doi: 10.1186/s12962-019-0172-9. eCollection 2019.
Recent years have witnessed a strong tendency to apply economic evidence as a guide for making health resource allocation decisions, especially those related to reimbursement policies. One such measure is the use of the cost-effectiveness threshold as a benchmark. This study explored the threshold for use in the health system of Iran by determining society's preferences.
A cross-sectional household survey based on the contingent valuation method was administered to a representative general population of 1002 in Tehran, Iran from April to June 2015. The survey was intended to estimate the respondents' willingness-to-pay (WTP) preferences for one quality-adjusted life year (QALY) gained. The valuation scenarios featured 12 vignettes on mild to severe diseases that can change people's quality of life. The mean of WTP for QALY was estimated using different health instruments, and the determinants of such willingness were analyzed using the Heckman selection model.
WTP for QALY varied depending on the severity of a disease and the instrument used to determine health preferences. Mean low health state value were associated with high valuation. The best estimated WTP values ranged from US$1032 to US$2666 and 0.22-0.56 of Iran's local gross domestic product (GDP) per capita in 2014. Except for educational level, significant variables differed across different disease scenarios. Generally, a high health state valuation for target diseases, high income, high educational level, and being married were associated with high WTP for QALY.
From the general public's perspective, the monetary value of QALY for mild to severe diseases with no risk of death was less than one GDP per capita. Therefore, the obtained valuation range is recommended as reference only for the adoption of interventions designed to improve quality of life. Future studies should estimate the threshold of interventions for life-threatening diseases or formulate transparent policies in such contexts.
近年来，有一种强烈的趋势，即将经济证据用作卫生资源分配决策（尤其是与报销政策相关的决策）的指导依据。其中一项措施是使用成本效益阈值作为基准。本研究通过确定社会偏好来探索伊朗卫生系统中使用的阈值。
2015年4月至6月，对伊朗德黑兰具有代表性的1002名普通人群进行了基于条件价值评估法的横断面家庭调查。该调查旨在估计受访者为获得一个质量调整生命年（QALY）的支付意愿（WTP）偏好。评估情景包括12个关于可改变人们生活质量的轻至重度疾病的 vignette。使用不同的健康工具估计QALY的WTP均值，并使用Heckman选择模型分析这种意愿的决定因素。
QALY的WTP因疾病严重程度和用于确定健康偏好所使用的工具而异。低健康状态均值与高估值相关。最佳估计的WTP值在1032美元至2666美元之间，占2014年伊朗当地人均国内生产总值（GDP）的0.22 - 0.56。除教育水平外，不同疾病情景下的显著变量有所不同。一般来说，对目标疾病的高健康状态估值、高收入、高教育水平和已婚与QALY的高WTP相关。
从公众角度来看，对于无死亡风险的轻至重度疾病，QALY的货币价值低于人均GDP。因此，建议将获得的估值范围仅作为采用旨在改善生活质量的干预措施的参考。未来的研究应估计危及生命疾病干预措施的阈值，或在此背景下制定透明政策。
